Provider Demographics
NPI:1144067125
Name:RALSTON, RICK MARVIN (MS, LAC, NCC)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:MARVIN
Last Name:RALSTON
Suffix:
Gender:M
Credentials:MS, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10521 HARROW HEATH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-9368
Mailing Address - Country:US
Mailing Address - Phone:479-883-0610
Mailing Address - Fax:
Practice Address - Street 1:4001 BROOKEN HILL DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-9288
Practice Address - Country:US
Practice Address - Phone:479-883-0610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2406008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health